LETTER TO THE EDITOR
Auricular reconstruction with the use of a modified
Received: 8 February 2007 / Accepted: 10 August 2010 / Published online: 26 August 2010
We describe a simple, safe one-stage procedure for
reconstruction of marginal helical defects.
Auricular reconstruction after trauma, burn or local
excision of tumours has been a common challenge in
Apart from functional importance, the ear also has great
aesthetic value, because it frames the face and provides
A common defect on the ear is partial loss of the helical
margin with or without a cartilage defect.
Keeping general principles in mind, one can consider
various surgical options, based on a reconstructive triangle
One effective solution is the use of the rhomboid flap
The skin defect over the superior part of the ear can be
covered by a superiorly based random pattern post-auricular
flap designed on the non-hair bearing area, this has the
advantage of having the same skin colour as the original
auricular skin (Figs. 1, 2, 3 and 4).
Although the dimensions and shape of both defect and
flap are precise, they are variables in planning, namely
which of four potential flaps should be used, and the axis
around which the excisional rhomboid is be drawn.
It is possible to manipulate these variables in such a way
that closure of the secondary defect makes use of the laxity
of the skin present (use of Dufourmental instead of Limberg
A further advantage of this flap is that the donor site
scarring comes to lie behind the ear and is, therefore,
The anterior edge of the flap can be cut along the retro-
The greater skin mobility on the post-auricular surface,
coupled with the fact that ear tolerates being set back closer
to the head, increases the role of this flap considerably.
There is some loss of the curve of the helical margin, but
patients tend to be in an older age group and thus the result
can be acceptable.
For small defects, a simple transposition flap that is
designed as a formal rhomboid flap is a useful option
(Figs. 5, 6).
In this situation, Fortier-Riberdy et al. gave some useful
– Carefully measure the needed length of the flap and add
a triangle to make closure of the secondary defect easier.
– Lift the flap including the triangle to ensure sufficient
defect coverage before trimming the flap.
– Place the first suture at the tip of the flap and secure it
to the remaining helix with a vertical mattress to
provide good wound aversion and avoid a notch on the
E. Anesti (*)
Plastic Surgery Department, Pinderfields General Hospital,
Eur J Plast Surg (2010) 33:311–313